BICYCLE HELMET USE: Arguments for and against compulsion

Many cyclists report being nude without their polystyrene prophylactics and this must be music to the ears of suppliers and retailers who sell cycle helmets but if legislation was enacted that forced cyclists - under-16s first, but the Bicycle Helmet Inititiative Trust wants compulsion for all - to don head protection would this fill bike trade tills or would the scaring away of non-enthusiast cyclists lead to a smaller market?

In this minefield of a topic, there are some strongly-held points of view. BikeBiz.com invited some key figures and organisations in the compulsion debate to lodge their arguments.

So, as well as the anti-compulsion argument of the National Cycle Strategy Board, here are polemics from a brain surgeon, two UK suppliers of branded helmets, the nurse who founded BHIT, and others. At the base of the article are some PDFs and websites for further reading.

NATIONAL CYCLE STRATEGY BOARD

Arguments that appear to disavow the efficacy or utility of cycle helmet wearing, or on the other hand claim it as the major influence in reducing injury to cyclists, are both wide of the mark. In particular, campaigns seeking to present cycling as an inevitably dangerous or hazardous activity, or which suggest that helmet wearing should be made compulsory, risk prejudicing the delivery of those very benefits to health and environment which cycling can deliver: they also serve to confuse the general public about the wider social and economic advantages of cycling. As a result, the NCS Board is anxious that the question of wearing helmets is placed in its proper context.

The NCS Board has a clear view on this issue, which is that it must remain a decision for individuals as to whether to wear a helmet for some or all of their various cycle activities. Parents will need to take this decision on behalf of their children, bearing in mind all the particular circumstances. But any mandatory requirement to wear helmets on all occasions would greatly dilute the benefits which safe cycling can offer our society as a whole.

TERRY BOWLES

Chief executive of Madison, UK importer of Giro helmets

Putting aside the commercial arguments for or against the compulsory wearing of bicycle helmets, which to our way of thinking is inconclusive one way or the other, I am compelled to say that if the greatest deterrent to more people cycling in the UK is safety on roads, then it makes sense for cycle helmets to be made compulsory for all road users. It is a fact that more people are now wearing helmets when cycling and so momentum is building. It is also the case that modern helmets are lighter, more comfortable to wear, easy to fit/use/ adjust, more pleasing to the eye and great value for money, so the majority of objections to wearing a helmet have been taken away.

In our opinion, if we are going to encourage more people to cycle more often, we must be responsible and consistent when talking about their safety.

Speaking on behalf of Madison, I am happy to say that the compulsory wearing of cycle helmets on road would be a step forward in the process of advancing our cause as an industry.

JOHN FRANKLIN

Cycling skills consultant

For the past 15 years cyclists have been told that if they wear cycle helmets, they are significantly less likely to suffer head injury. Research predictions of a 88 percent reduction in brain injuries and a 90 percent reduction in fatalities are the keystones of helmet promotion to this day.

Whilst many cyclists have not liked the idea of wearing helmets, and even less of being obliged to do so through compulsion, much of the opposition to helmets has, until recently, been based around freedom of choice. But in the past few years analysts in several countries have started to look at the subject more objectively, spurred on in Britain by court cases seeking to reduce compensation to unhelmeted cyclists with head injuries, and by the detrimental effect that helmet promotion is seen as having on achieving targets to encourage cycle use.

Far from achieving huge reductions in head injuries and deaths, traffic casualty statistics for Great Britain show no discernible benefit from cycle helmets over trends during the past two decades. Indeed, where trends have changed, the number or severity of injuries has increased. For example, in London where around half of cyclists now wear helmets, injury severity in 2001 was significantly greater than in 1981 and fatalities were the highest since 1989. This cannot be attributed simply to traffic conditions. The severity of pedestrian casualties, which tracked those of cyclists until the mid 1990s, has continued to decline.

There has been a similar experience in other countries where helmet promotion is strong. In the USA the likelihood of head injury rose by 40% between 1991 and 2001, although helmet use tripled to 50% and cycling fell by 21%. In Australia and New Zealand, data that takes account of the large drop in cycle use brought about by helmet laws shows that the average cyclist in those countries is now more at risk of head injury than previously.

But the failure of helmets to deliver what has been promised of them is only part of the picture. Research shows clearly that cycling is a very safe activity, delivering health benefits that far outweigh the risk of injury. If risk of any injury is low, so the risk of head injury is much lower still, taking over 3,000 years of average cycling to suffer a serious injury to the head. Contrary to what is sometimes suggested, cyclists are a little less likely to die of head injury than are pedestrians or car occupants.

Cycling regularly to work has been shown to be by far the most effective way that a person can increase their life span, and the best way to improve safety further is to get more people to cycle. Yet, thousands of people have been scared from cycling by helmet promotion who might otherwise gain greatly from the health benefits. At the same time obesity and heart disease have become the principal causes of premature death in Britain, killing annually more than 500 times as many people as cycling. No-one will suffer more from these trends than children.

For too long the promotion of helmets has been an end in itself. We need to step back, place all the facts on the table, and look at the full consequences for cycling and public health.

GORDON FISHER

Fisher Outdoor Leisure plc, UK importer of MET helmets

As the distributor of the UK's leading branded cycle helmet you may well think that as a company we would be in favour of cycle helmet legislation. This would be the case if it were mandatory to only wear MET cycle helmets!

There is no doubt that this increased use of cycle helmets and the greater awareness by car users towards cyclists has reduced cycle fatalities over the last 20 years.

Some campaigners say that cycle helmets are of limited use - particularly for adults. But a team from Imperial College London has found that the number of serious head injuries among cyclists of all ages has fallen as a result of increasing helmet use.

I would say that it is mad to cycle not wearing a helmet, it is also mad to smoke, mad to drink like a fish, mad to cross when the red man says stop, mad to do plenty of things that are not illegal.

Although I would advocate campaigns to increase cycle helmet usage I would not support any lobby for compulsory use.

Hasty legislation will not benefit the cycle trade. The product will become more of a commodity item, similar to tea and coffee and will be sold in similar outlets. The retail price will fall to around £8-10 making quality branded helmets appear an over-priced luxury. It would be a marvellous loss leader for a supermarket chain, a great give-away for a cereal brand, but not good for bike shops.

A lot of leisure and sport cyclists already wear good-quality cycle helmets; the more casual cyclist and those who have chosen not to wear a helmet may stop cycling altogether. Cycle usage dropped quite dramatically in Australia due to irresponsible promotion of helmets portraying cycling as an extremely dangerous activity.

Cyclists must be genuinely convinced of the benefits cycle helmets bring. My suggestions:

* Immediate introduction of a monitoring system (accident study and a survey of helmet-wearing rate) as there are no official statistics.

* The use of numerous national and local campaigns to increase the helmet-wearing rate to 75% among children and 50% among sport, leisure and commuters within 5 years.

* The campaigns should be aimed in the first place at children, their parents and casual users of cycles. The message should deal primarily with individual awareness of risk but should also address incorrect assertions such as "a helmet wearing takes away the feeling of freedom" or "cycling helmets are not attractive".

Compulsory wearing of helmets may turn the responsibility of accidents from society in general towards the individual cyclist. This is the case in Denmark, Norway and Sweden, where cyclists are blamed for not using helmets in an accident, rather than poor driver behaviour or poor road design.

Let individuals make an educated choice to wear a helmet and to make sure their children wear helmets.

Most helmet sales today are not distress sales, those buying them want to buy them for aesthetic reasons as well as safety reasons. Part of the motivation may be the function of the product but the overwhelming factor is 'I like the look of this one', otherwise everyone would drive a Volvo.

ANGELA LEE

Chief executive of BHIT, the Bicycle Helmet Initiative Trust

The gap between BHIT and the cycling industry has continued to be forced further apart because of the obvious fear factor by the industry which is fuelled only by those opposed to helmets giving a one-sided view of helmet use. I would like to take this opportunity to clarify the objectives of BHIT and these are that BHIT is pro helmet wearing, it focuses purely on children. A child is 20 times more likely to be injured than an adult cyclist. Their needs are very different but the adult response to helmets only detracts from an important safety issue that could save a child's life or prevent permanent disability.

BHIT has never pushed for mandatory helmet wearing for adults. However we are, of course, concerned as should every one in the bike industry should be, about the welfare of all cyclists.

The under 16s have always been our concern. Children do not always do what they are told and that is why child cyclists are twenty times more likely to come off their bikes than an adult.

Unfortunately, 45 percent of child cyclists who attend the Emergency Departments have sustained a head injury. Approx-imately 90 000 under 16-year olds seek hospital treatment for injuries sustained on their bikes each year. Thirty percent of children's head injuries admitted to hospital are due to cycle accidents.

To adequately appreciate risk of potential injury you need to calculate the exposure to the activity. Pedestrian injuries will always be significantly higher through the sheer volume of them. Simply you need to look at like with like and it has been clearly documented that cyclists are at greater risk, and especially children.

DR. MEYER HILLMAN

Senior Fellow Emeritus at the Policy Studies Institute, London

By wearing helmets, cyclists are, at best, only marginally reducing their chances of being fatally or seriously injured in the rare incident of a collision with a motor vehicle.

[Protective devices encourage higher levels of risk taking]. Imagine youre driving a car in the outside lane of the motorway and a wasp has got under your seat belt. To free the insect you undo your seat belt.

Instinctively you slow down the car because now youre not strapped in, you feel vulnerable.

The problem is you cant show how many cyclists have avoided head injury by riding with more vigilance. However studies show that when you dont wear a protective device you compensate for the risk you run. For instance, if motor vehicles were fitted with a spike in the centre of the steering wheel which pointed towards the drivers chest, the driver would drive slower in the knowledge that should they hit something theyd be the first to get hurt.

[By being more careless, the helmet-wearer is using up any extra protection offered]. Cycle helmets provide limited protection for the head. Neither manufacturers nor retailers tell the public this.

Youre much better off cycling with extra care than you are wearing a helmet and riding with an exaggerated sense of security.

If you tell them they should always wear a helmet when they ride youre reinforcing their belief that its dangerous. I have calculated that the health benefits of regular cycling in terms of life years gained through increased longevity, far outweigh the loss of life years in cyclists deaths.

ALISTAIR JENKINS

Consultant neurosurgeon at Newcastle General Hospital

I have to pick up the pieces when people have accidents, often literally. I see the results of both wearing and not wearing helmets.

I have looked after cyclists who have been involved in accidents who have died, been severely disabled and some who have made a good recovery. I have never looked after a cyclist who was wearing a helmet who later died or was disabled.

However, I dont want to give the impression that I operate on lots of injured cyclists all the time. I see far more pedestrians and motorists.

When a motorist has an accident they are often in a pretty bad way. Although a cycle helmet won't protect you in every incident of ground impact, by the time a cyclists head actually hits the ground they will be decelerating and, even if they were cycling at 30 miles an hour, the impact would be at no more than 10-15 miles an hour.

The argument that cyclists who wear helmets take more risks than those that do is rubbish. If I crash it could be my arms and legs that get injured, theyre not going to be protected at all. I ride safely at all times.

I now feel naked without my helmet. Okay, so you dont get the wind in your hair but that bothers you the first couple of times you go out.

Look at the positives, what you lose in terms of ventilation you gain in shelter from the sun and rain.

Im not in favour of compulsion because wearing a helmet is a matter of personal choice but I think children should be made to wear them. They naturally take risks, and fall down more, its a part of growing up. Adults can make a logical choice whether they think a cycle helmet is right for them, kids cant make those sorts of decisions by themselves.

CARLTON REID

Editor/publisher of BizeBiz.com

I wear a helmet, my three young children wear helmets but that's our choice. Forcing kids to wear helmets will be bad for UK cycling. By and large, Dutch cyclists don't wear helmets and there are no epidemics of head trauma caused by cycle accidents in the Netherlands.

Let's get kids active and out there cycling. Obesity is a proven HUGE killer, the safety benefits of helmets are obvious for low-speed crashes on to curbs from 1m but unproven for anything beyond this. However, many helmet campaigners seem to think helmets will be a panacea for all cycle-related head trauma.

Unfortunately, motorists think so too and speed up to pass helmet-clad cyclists because they are seen to be 'protected' and 'serious cyclists'. (Source: TRL 549, Drivers' perceptions of cyclists). Motorists pass such 'serious' cyclists much closer than they would have done otherwise. If you fall from a bike at 12 mph, your head will be nicely protected from the impact of the road (should you land head-first, which is unusual) but the polystyrene would offer little protection against a car running into you once you've survived the fall.

Department of Transport campaigns for kids to wear cycle helmets are sensible, children fall off bikes lots (only a tiny fraction injure themselves when doing so), but mandation is a step too far.

If Mr Martlew and the Bicycle Helmet Initiative Trust truly wanted to save lives they would campaign for helmets to be worn by children at all times, not just when cycling.

Forcing people to wear helmets will lead to a huge drop in levels of cycling in this country. Can you really imagine fair-weather, now-and-again, take-it-or-leave-it cyclists rushing out to buy helmets? Or is it more likely theyll decide to walk or drive the one mile to the newsagents rather than wear what they consider to be silly, and largely unnecessary lumps of polystyrene (a serious head injury occurs only once every 3000 years of average cycling)?

A seatbelt law was swallowed  and is observed  because the great majority of British adults are motorists. Most people feel they have to drive, so comply with the law. Cyclings not like that. Its a delicate flower, easily crushed. In my opinion, a mandatory helmet law would be disastrous for the British bike trade.

Pro-helmet scare tactics, well-meaning though they may be, dont tend to make parents rush out and buy helmets for their cycling offspring, they just discourage them from cycling altogether.

More children die of head injuries within the safe confines of cars, than die from cycle-related head injuries. Would the government dare to make motorists and pedestrians wear helmets? What about legislating helmet use for those who live in houses with low ceiling beams?

Sure, there are sackloads of anecdotes from cyclists whose lives have been saved by helmets and many cases where helmet-less riders have been killed or seriously injured but, equally, there are cyclists who have never worn helmets and who have added years to their lives thanks to their regular cycling. Helmet wearing has got to be a matter of personal choice.

MALCOLM WARDLAW

Transport consultant

Its often stated that 4.8 times as many car occupants and 3.7 times as many pedestrians (or numbers to this effect) die of head injuries as compared with cyclists. These figures are incorrect, but they have been bandied about for years and have thus gained credibility by repetition.

About 14 times as many car occupants as cyclists suffer lethal head injuries per year in road accidents, and about six times as many pedestrians (or seven times, if you include deaths in falls, which are not included as traffic deaths). Cyclists tend to suffer less from lethal injuries to other parts of the body than other road users, that is, they get less comprehensively mangled than others. Thus the head injuries tend to stand out more to the casual observer, but actually, cyclists are less likely than car occupants to suffer lethal head injuries in a fatal accident (82 percent as against 86 percent of fatalities, according to published information).

The figures of4.8 times as many car occupants and 3.7 times as many pedestrians bandied about by were developed in the late 1980s, when the medical profession was scraping around to find reasons for only cyclists to wear helmets. It was noted that cyclists suffered fewer non-head lethal injuries than occupants and pedestrians, but this fact was twisted into the notion that cyclists suffered worse head injuries than other road users.

Dont be fooled. French research actually shows that it is pedestrians that suffer the most serious head injuries in road accidents, not cyclists.

Cycling is demonstrably a very low risk activity; even at present, the average British cyclist may only expect to suffer a serious head injury once in 3,000 years of cycling, and fatal injury once in 20,000 years. Cycling in Britain bears lower long term risks than driving in many Continental countries.

Cycling gets safer as it gets more popular. There is now a wide range of evidence that increasing cycling levels alter driver behaviour in a manner that reduces the risk of death per cyclist by a large amount. In fact, the only measure that does reduce the fatality rate at the population level is an increase in cycling. But, note that a reduction in cycling will increase the risk of death.

There were doubts about the safety of road cycling before helmets became an issue  and cycling does look dangerous from the roadside and from within a car. Cyclists could not have come up with a more effective means to confirm these safety doubts than embracing helmets as a good thing and publically wearing them. The biggest deterrent to mass participation in cycling is the belief that it is dangerous.

Since 1999, two very high quality studies have appeared showing that helmet use rising from nil to 85-90 percent in New Zealand and Western Australia had either no effect or only a trivial effect on the head injuries being suffered by cyclists. These are careful studies by reputable sources; the Otago Injury Prevention Unit and the Public Health Dept of the University of Western Australia.

It is scandalous that the road safety establishment complacently ignores these results and continues to insist that helmets are very beneficial.

Cycling will only be really well served in this country  and materially safer than it already is  when it becomes popular, but it will never be popular as long as there are cyclists who think it wise to present cycling as a rather risky activity.

Cyclists fail to appreciate how they harm their prospects in presenting cycling as a dangerous activity.

Imagine if all cyclists from tomorrow just went out in normal wear, casual trousers and jerseys and so forth, with not a helmet in sight. Cycling is a charming, harmless, healthy and pretty safe activity.

More and more cyclists on the roads is far and away the most powerful safety feature for cyclists. There is safety in numbers and only in numbers. Bear that in mind, next time you don your lid just to cycle across town.

PRO HELMET NURSERY RHYME

By trainee doctors Sarah Giles and Sarah Shea,

published in Canadian Medical Association Journal, 2004

Little Johnny rode his bike,

No helmet on his head.

He took a fall and split his skull,

His mother feared him dead. She rushed him to the ER,

Where they checked his neuro signs.

They noted a blown pupil

And inserted IV lines. They called the neurosurgeon,

Who came in and drilled a burr.

Now Johnny's fine; he rides his bike,

But he's helmeted, for sure.

QUOTE FROM AUTHOR C.S. Lewis (1898-1963)

"Of all tyrannies a tyranny sincerely exercised for the good of its victims may be the most oppressive. It may be better to live under robber-barons than under omnipotent moral busybodies. The robber-baron's cruelty may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience."

"Helmets might have saved 14 lives in 15 years. A similar calculation based on the controls suggests that if all pedestrians and vehicle occupants had worn helmets, 175 lives might have been saved in the same period. CONCLUSIONS: There is no justification for compelling cyclists to wear helmets without taking steps to improve the safety of all road users."